The Revised Atlanta Classification is the Strongest Predictor of Mortality in Patients with Acute Pancreatitis: A Study on 358 Patients

Abstract

Background: Acute Pancreatitis (AP) presents with a wide range of severity and has varying outcomes. We report our experience with 358 consecutive patients with AP admitted to a tertiary care centre in North India for two years. Methods: In this retrospective study, clinical, biochemical, radiological, and treatment-related data of patients admitted with AP was collected and analysed. Predictors of 120-day mortality and treatment outcomes were analysed. Results: 358 patients (median age 42 years, 78% males) were included. The most common aetiology was biliary (37%) and alcohol (32%). Sixty-nine percent of patients had severe disease at admission according to the revised Atlanta classification. A total of 81 of 358 patients (23%) died within 120 days, with most of the deaths occurring within the first month of illness. A significant proportion of patients having severe AP (74/248, 29.8%) succumbed to illness, while only 6.4% (7/110) patients with mild or moderately severe AP had mortality within 120 days. On multivariate (Cox regression) analysis, the independent factors predicting 120-day mortality were: CT severity index >5 (OR 4.4), presence of respiratory failure (OR 14.9), presence of circulatory failure (OR 4.4), and severe pancreatitis on admission according to revised Atlanta classification (OR 56.4). Conclusions: Biliary and alcohol are the most common aetiologies of acute pancreatitis in north India. Acute pancreatitis still carries a poor outcome with a 23% mortality rate. Patients having severe pancreatitis at admission, according to revised Atlanta classification, are at the highest risk for mortality and should receive intensive care..